Provider Demographics
NPI:1831215623
Name:WELLINGTON REGIONAL DIAGNOSTIC CENTER LLC
Entity type:Organization
Organization Name:WELLINGTON REGIONAL DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-798-8500
Mailing Address - Street 1:3537 FOREST HILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5867
Mailing Address - Country:US
Mailing Address - Phone:561-965-1199
Mailing Address - Fax:561-964-6359
Practice Address - Street 1:3537 FOREST HILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5867
Practice Address - Country:US
Practice Address - Phone:561-965-1199
Practice Address - Fax:561-964-6359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR672900261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5817Medicare UPIN